Stump appendicitis: preoperative imaging findings in four cases
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Abdominal Imaging
Abdom Imaging (2013) DOI: 10.1007/s00261-013-0008-6
Stump appendicitis: preoperative imaging findings in four cases Elena Martı´nez Chamorro, Alicia Merina Castilla, Beatriz Mun˜oz Fraile, Laura Koren Ferna´ndez, Susana Borruel Nacenta Emergency Radiology Section, Department of Radiology, Hospital Universitario 12 de Octubre, Avda. de Co´rdoba, s/n, Madrid 28041, Spain
Abstract Appendiceal stump appendicitis is a rare entity caused by inflammation of the appendiceal remnant after incomplete appendectomy. We describe four patients with inflammations of the appendiceal stump, which were preoperatively diagnosed using ultrasonography and/or multidetector computed tomography. Stump appendicitis is a complication that should be taken into consideration when patients with a history of appendectomy present with right lower quadrant pain. Imaging techniques play a key role in the diagnosis. Key words: Stump appendicitis—Appendectomy— Preoperative diagnosis—Ultrasound—Computed tomography
Stump appendicitis is a rare complication of appendectomy. It is defined as the interval-repeated inflammation of the remaining residual appendiceal tissue after appendectomy. The clinical presentation does not differ from acute appendicitis, but its diagnosis and treatment are often delayed by the previous history of appendectomy. We present the imaging findings of four patients with stump appendicitis. Early diagnosis and management must be done to prevent complications.
Case reports Case 1 A 15-year-old boy presented to the Emergency Department with a 48-h history of right lower quadrant pain and fever (38 °C) without nausea or vomiting. His medical history only revealed an open appendectomy
Correspondence to: Elena Martı´ nez Chamorro; email: [email protected], [email protected]
two years earlier in another institution. Abdominal examination showed a well-healed McBurney’s scar and tenderness in the right lower quadrant without evidence of guarding, rebound, or other peritoneal signs. Routine laboratory studies were remarkable for a white cell count of 13.100 cells/mm3 with 74 % neutrophils. Abdominal sonography showed a blind-ended tubular structure 28 mm long and 9 mm wide extending from the cecum, below the ileocecal valve, consistent with a dilated appendiceal stump (Fig. 1). It was associated with a fluid collection adjacent to the tip, hyperechogenic periappendiceal fat, and small mesenteric lymph nodes. Acute stump appendicitis was confirmed at surgery, which was carried out through the previous McBurney’s incision. The appendiceal stump was resected the stump inverted into the cecum using a purse-string suture. The patient did well post-operatively and was discharged 6 days after admission. The surgical pathology report revealed acute phlegmonous stump appendicitis.
Case 2 A 38-year-old man with no remarkable medical history except for an open appendectomy as a child was admitted to the Emergency Room for a 3-day history of pain in the right iliac fossa, nausea without vomiting, and
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